In a case series of 2,788 patients treated over a 12-year period, patients achieved a 61% reduction in shoulder pain and improved function by 34.3% compared with baseline, said Luca M. Sconfienza, M.D., of Santa Corona Hospital and the University of Genoa in Genoa, Italy.

The use of two needles rather than one resulted in more complete aspiration of calcium from the shoulder because the aspiration is aided by "constant pressure from the saline infusion in the other needle," Dr. Sconfienza told attendees at the Radiological Society of North America meeting. "This is an in-and-out approach."

Moreover, despite the use of 16-gauge needles, "which are about one-third bigger than the needles used in single-needle lavage/aspiration, there were no tendon tears associated with the procedure," Dr. Sconfienza said.

Using this technique, all the calcium in the shoulder was removed in 70.1% of procedures. In 23.5%, the calcium was reduced by more than 50%.

Dr. Sconfienza said the procedure was also inexpensive -- he estimated the cost of therapy at $98 per procedure. But he said that all patients were referred for physical therapy, which would be an additional cost.

He said, too, that the procedure could also be used to aspirate calcium deposits from other joints -- knees and elbows for example. He estimated that 7% to 10% of the general population develops calcium in joints.

Philip O. Alderson, M.D., of Columbia University, who chairs the RSNA communications committee, said that, as a concept, lavage and aspiration is not new, but, he said, the two needle approach was novel.

Dr. Alderson said the procedure is likely to work best when the calcium is contained in a gelatinous matrix, but was probably not effective for removing hardened calcium.

Dr. Lacelli agreed with this observation, but, she added, "the pain of tendinitis usually subsides when calcium hardens," whereas patients with a "gelatinous matrix" are likely to experience significant pain.

"Our patients were all very symptomatic, which may explain why the procedure was so successful," she said.

Drs. Sconfienza, Lacelli, and Alderson said they received no research funding, honoraria, or consulting fees from imaging companies or the pharmaceutical industry. The study was investigator initiated and institutionally funded.

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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